Lijuan Liu ¹ Chenhan Wang ¹ Jie Dong ² Jiayi Lin ¹ Mingxiao Liu ³ Wei Li ³ Debin Zeng ¹ Xiaohui Yang ¹ Xicheng Deng ^1*

• ¹ Department of Cardiothoracic Surgery, The Affiliated Children's Hospital of Xiangya School of Medicine, Central South University (Hunan children’s hospital), Changsha, Anhui Province, China
• ² Pediatrics Research Institute of Hunan Province, The Affiliated Children's Hospital of Xiangya School of Medicine, Central South University (Hunan children’s hospital), Changsha, China
• ³ Xiangnan University, Chenzhou, Hunan Province, China

Objective: To retrospectively assess the outcomes of open-heart repair for ventricular septal defect in children using a right vertical axillary incision compared to median sternotomy. Method: From January 2022 to May 2023, children who underwent open-heart surgery for the repair of ventricular septal defects in our department were selected for a propensity score-matched study. The propensity score matching method was utilized to pair children in the right vertical axillary incision group with those undergoing surgery via median sternotomy at a 1:1 ratio, based on age and weight. Results: There were 35 cases in each group of patients. In the right vertical axillary incision group, the median age was 15 (7 ~ 40 ) months and the median weight was 8 ( 7 ~ 12 ) kg. In the median sternotomy group, the median age was 7 (3 ~ 37) months and the median weight was 7 (5 ~ 14 ) kg. The age (Z = -1.871, p = 0.061) and weight (Z = -1.462, p = 0.144) of the two groups showed no significant differences. The right vertical axillary incision group exhibited a significantly shorter incision length compared to the median sternotomy group (p < 0.001). Additionally, the median postoperative drainage was lower in the right vertical axillary incision group than in the median sternotomy group (p = 0.044), indicating statistical significance. No significant differences were observed between the groups concerning operation time (p = 0.565), bypass time (p = 0.855), cross-clamp time (p = 0.204), oxygenation index one hour post-surgery (p = 0.651), pleural effusion at 12 hours post-surgery (p = 0.470), abnormal postoperative electrocardiogram (p = 0.452), cardiac intensive care unit duration (p = 0.211), or length of hospital stay (p = 0.095). The hospitalized children were followed up for 3 months to 1 year, during which there were no fatalities or complications. Conclusion: Open-heart repair of a ventricular septal defect through a right vertical axillary incision is a safe and effective surgical technique that minimizes surgical trauma and enhances aesthetic outcomes.